2010 Major Accomplishments

Patient Protection and Affordable Care Act On March 23, 2010 the Patient Protection and Affordable Care Act was passed. Tribes are among the primary beneficiaries of the insurance reforms, grant programs, and cost-saving measures of the Affordable Care Act. American Indians and Alaska Natives can continue to be eligible for and use Indian Health Service (IHS), Tribal, or urban Indian health programs, but if they want to, they will be able to purchase health insurance through the new health insurance exchanges, authorized in this bill, which should have more affordable options. If AI/AN individuals don’t want to purchase health insurance, as long as they get their care through our I/T/U system, they won’t have to pay a penalty. The expanded eligibility for Medicaid in the health reform bill will also likely help many patients in Indian Country.

Indian Health Care and Improvement Act Along with the passage of the Patient Protection and Affordable Care Act, the Indian Health Care and Improvement Act was permanently reauthorized on March 23, 2010. This bill was first approved by Congress in 1976 and prior to this year’s passage had not been updated or reauthorized by Congress. The bill permanently reauthorized the Indian Health Service. The bill is a critical step in modernizing the Indian health care system and improving access to health care for American Indians and Alaska Natives.

The Affordable Care Act Outreach Plan The Office of Intergovernmental Affairs (IGA) developed an outreach plan to provide tribes with more information and opportunities to consult on the Affordable Care Act and the provisions that affected them as tribes and individuals. Each quarter, the Department will compile information on activities of the Department of Health and Human Services (HHS) relating to Indian Country and the Affordable Care Act. This quarterly report is intended to bring to the attention of tribes, tribal organizations, urban Indian organizations, and American Indian and Alaska Native (AI/AN) individuals and families important funding opportunities, consultation sessions, informational meetings, and other efforts relevant to tribal communities that have been implemented at HHS during this period. HHS also engages tribal partners in monthly conference calls, listening sessions, and weekly emails. It is our intention that this outreach effort will complement and enhance the interagency implementation effort and improve communication between the federal government and tribes.

HHS Tribal Consultation Policy As part of the Department’s efforts to implement all legislative mandates, as well as to respond to the President’s memorandum of November 5, 2009, regarding tribal consultation policies at Executive Branch departments and agencies, Secretary Sebelius asked for a revised Tribal Consultation Policy (TCP). HHS completed eight regional consultation sessions in May 2010 and created a Tribal-Federal Work Group (TFWG) in July 2010 to review the reports of the regional sessions and revise the Department’s TCP. The TFWG completed a revised draft policy. This draft HHS TCP was sent to Tribal leaders to seek their input on October 7, 2010. Secretary Sebelius signed the revised Tribal Consultation Policy on December 14, 2010, at the first convening of the Secretary’s Tribal Advisory Committee (STAC).One of the changes found throughout the policy is that tribal input will be sought “throughout all stages” of the development of policies, regulations, and budgets. Another substantive change is the new requirements regarding HHS’ duties in reviewing authorizing statutes and regulations to determine if Federal program funding must be distributed to States rather than directly to Tribes in all instances where this practice is operating. In addition, references to non-Federally recognized groups of Indigenous people have been removed. The majority of revisions or additions to the policy were to clarify the roles and responsibilities of the Divisions in carrying out the policy.

Secretary’s Tribal Advisory Committee (STAC) As part of the Department’s efforts to improve services, outreach, and consultation efforts with tribal partners and be responsive to the President’s memorandum of November 5, 2009 regarding Tribal consultation, Secretary Sebelius requested that a Secretary’s Tribal Advisory Committee be developed and convened. The establishment of a tribal advisory committee at the Secretarial level will create a coordinated, department-wide strategy to incorporate tribal guidance on HHS priorities, policies and budget, improve the Government-to-Government relationships, and mechanisms for continuous improvement with our services to Indian Tribes. On October 7, 2010, Secretary Sebelius announced the development of the STAC; on December 6, she announced the members of the Committee; and on December 13 & 14, the STAC was convened for the first time.

Administration for Children and Families (ACF) Tribal Consultation Policy In August of 2010, ACF established a Tribal/Federal Workgroup made up of Tribal leaders and at-large members from within ACF’s regional offices to develop an ACF Tribal Consultation Policy. The workgroup met several times and presented the draft policy for discussion this past September during the ACF Tribal Consultation Session. The draft policy was published in December 2010 for a 45 day comment period ending January 31, 2011. ACF is reconvening the workgroup March 7 & 8 to review the comments and revise the policy. In the spring of 2011, ACF anticipates publishing its final Tribal Consultation Policy. ACF will implement the policy immediately through a series of briefings to ensure ACF employees are aware of the policy and how consultation works.

HHS February 22, 2010 Plan to Implement the Presidential Memorandum on Tribal Consultation

On February 22, 2010, Secretary Sebelius submitted a letter to Office of Management and Budget (OMB) Director, Peter Orzag, that outlined a plan to be a leader within the Administration for Tribes and Tribal consultation and described the Department’s compliance with Executive Order 13175. The letter focused on five primary ways that HHS would work to improve relationships with tribes: annual budget consultation, regional consultations, tribal delegation meetings, individual agency consultations and consultation policies and a written consultation report.

2010 Annual Tribal Budget and Policy Consultation On March 4-5, 2010, HHS hosted the 12th Annual Department-wide Tribal Budget and Policy Consultation session in Washington, D.C. to facilitate FY 2012 budget recommendations. 183 tribal representatives and federal staff attended the two day session. Tribal representatives presented their priorities to senior leadership from HHS as well as to nine HHS agencies, including ACF, SAMHSA, CMS, CDC/ATSDR, NIH, AoA, AHRQ, and HRSA. Further discussion addressed both the IHS budget as well as cross-cutting issues including national health reform, the impact of state budget reductions in Indian Country, and wellness and prevention. Four main recommendations emerged, including providing block grant funds directly, coordinating efforts across HHS and with other federal agencies, increasing funding and increasing accessibility.

Regional Tribal Consultation Sessions The HHS Regional Tribal Consultation Sessions are designed to solicit Tribes’ priorities and needs on health and human services and programs. The Sessions provide an opportunity for Indian Tribes to articulate their comments and concerns on budgets, regulations, legislation and HHS health and human services policy matters. This year marks the 7th year of these consultation sessions in the field. Between March through May of 2010, HHS held eight regional tribal consultation sessions across the country with the goal of improving the HHS tribal consultation process, agency policies, and overall communication. Sessions were well-attended with over 200 of the federally recognized tribes participating.

National Congress of American Indians On March 2, 2010, Secretary Sebelius addressed the National Congress of American Indians at their Tribal Nations Legislative Summit and Executive Council Winter Session, which brought together tribal leaders, national, regional and local tribal organizations. The meeting is the one time of year that NCAI, the oldest and largest organization of elected tribal leaders, is in Washington, DC.

Tribal Leaders Roundtable On March 2, 2010, Secretary Sebelius held a tribal leaders roundtable at her office with elected tribal leaders from the Chickasaw Nation, Tohona O’Odham Nation, Poarch Creek Band of Creek Indians Pechanga Band of Luiseno Mission Indians, Oglala Sioux Tribe, Jamestown S’Klallam Tribe and the Tlingit and Haida Indian Tribe of Alaska. Discussion centered on government-to-government relationship, tribal consultation and the ways in which HHS can be helpful to advancing the needs of tribal communities across the country.

New Mexico Indian Country On July 21st, 2010, Secretary Sebelius visited New Mexico Indian Country. At the Pueblo of Jemez, the Secretary received a tour of the Visitor’s Center and engaged in a discussion with tribal leaders and children. The Secretary was then hosted at the Isleta Pueblo, lunched with Isleta Elders and visited children at the recreation center. Finally, the Secretary attended a discussion with tribal leaders at the Isleta Golf Course.

Tribal Leaders Meeting On December 15, 2010, Secretary Sebelius attended President Obama’s Tribal Leaders Meeting along with Secretary Salazar and Attorney General Holder. She gave an opening statement at the beginning of the meeting. The Tribal Leaders Meeting preceded the Tribal Nations Conference held each year in December at the White House.

270 Day Progress Report Toward Implementation of EO 13175 In August 2010, the Department of Health and Human Services submitted a progress report on tribal consultation activities in compliance with the President’s memorandum of November 5, 2009 which instructed all agency and department heads to provide a status update within 270 days of progress towards implementation of Executive Order 13175, “Consultation and Coordination with Indian Tribal Governments.” This report summarized the Department’s progress towards the HHS plan that was submitted in February, 2010 to the director of the Office of Management and Budget.